Pegasystems' SmartBPM® solution framework provides new levels of agility for healthcare organizations — integrating sales processes and optimizing sales channels to improve productivity and grow membership.

In today's competitive market, a disconnected sales process can prevent healthcare organizations from meeting key membership-growth objectives. High frequency of nonstandard quotes for unsupported benefit combinations, inconsistent premiums, manual rework, and sub-optimal interactions with distribution channels can impede new business opportunities. Faced with the need to maximize sales opportunities at every point along the sales process, healthcare organizations must bridge existing departmental and technological silos and effectively manage the sales cycle from prospecting through enrollment.

Built expressly for healthcare organizations, Pegasystems' Sales Process Manager™ is a packaged, scalable solution that intelligently manages the sales process, from opportunity management to quoting to rating and proposal generation through group contract submission.  Infused with healthcare intelligence, Sales Process Manager provides core sales-process functionality and the mechanism for rapid personalization and extension, allowing organizations to capitalize quickly on their unique differentiators.

Sales Process Manager addresses several significant sales challenges faced by all healthcare organizations:

• Delivering consistent and supportable sales quotes across all sales distribution channels
• Rapidly adding new products and markets to their sales portfolios as a response to increasing competition
• Increasing sales-distribution channels
• Maximizing sales-agent productivity

Key Benefits

By capturing business objectives, optimizing processes, and driving work to completion, Sales Process Manager gives users the necessary agility for:

• Productivity — Rules-driven product selection and guided next-step processing increase quote and enrollment accuracy, allowing timely completion of work and reducing rework. Real-time integration between systems and across users, census-upload facilitation, and correspondence automation boost the productivity of sales agents, allowing them to focus on building relationships and closing sales.
• Growth — Intuitive functionality promotes usage and drives acceptance by external parties such as broker-channel participants. Built for Change® technology enables the quick accommodation of new products, rating structures, and territories to provide rapid penetration of new markets and successful retention of existing business.
• Compliance — Role- and user-based system limits access to approved parties. Other rules control distribution of approved materials and products, manage service-level agreements,, and facilitate compliance with regulatory and customer-specific requirements.

The Solution

Built on Pegasystems' PegaRULES Process Commander®, a Business Process Management (BPM) system with a built-in rules engine, Sales Process Manager automates the sales cycle across products, sales channels, and users. It comes with 35 packaged best-practice sales workflows, a library of standard correspondence templates, over 1,200 defined rules, 15 representative users, and eight different user portals. It can be rapidly deployed and easily extended throughout a healthcare organization.

Familiar Visio tools make it easy to maximize the power of BPM. Users can personalize and extend any of the packaged sales workflows or create entirely new ones.

Key Functionality

Sales Process Manager delivers core functionality to support opportunity management, quoting, rating, proposal generation, and group enrollment:

• Creates and maintains prospect, agency, and broker profiles; manages prospect-focused activities (calls, meetings, literature requests); and provides on-demand or system-generated correspondence in multiple formats
• Imports Excel-based employee census data, automatically suggests product offerings, and delivers appropriate rate cards, allowing multiple sales representatives to create proposals for the same employer
• Provides effective-dated actuarial and underwriting tables that support multiple rating periods and deliver new customer ratings for multiple products
• Creates professional proposals with a cover letter, rate detail, and benefit summaries to share through multiple channels or to attach to a quote opportunity
• Streamlines opportunity closure by enabling employer-group sign-off through the directed Web-access function (secure one-time system access)
• Logically pre-populates enrollment fields, manages notification and approval process through relevant departments, electronically submits master contract data to legacy enrollment systems, and sends multi-channel correspondence to necessary parties
• Provides standard reporting on sales pipelines, inventory, and timeliness of work completion; comes with a report wizard that lets users easily create custom reports